gait parameters in individuals with spastic cerebral palsy. The muscles of the legs are active
for a longer period during BW training when compared with forward (FW) training, and a
longer period of muscle activity can result in greater muscle strength gain than with FW
training. Furthermore, training in BW could require higher physiological and perceptual
responses than FW at matched speed, as BW is the performance of a novel task for most
children with CP. BW treadmill training helps children with spastic CP to improve walking
capacity and decrease standing asymmetry of body weight distribution [123]. Treadmill gait
training helps such children to repeat task-centered activities while walking; accordingly, they
control velocity and develop a proper walking pattern by processing repeated sensory inputs
obtained during walking. It is effective for increasing the muscular strength of the knee
extensors and flexors as well as enhancing balance activities. Thus, it plays an important role
in improving the functional activities of children with cerebral palsy. Enhanced muscular
strength in the lower limbs causes adjusting the participants’ posture, improving dynamic
postural stability, and ultimately improving walking. Also, improved walking endurance and
muscle strength leads to improved gait performance after treadmill training [124].3.2. Robot-assisted therapyRobot-assisted therapy (RAT) is conducted using robotic devices that enable the patients to
perform specific limb movements. The main interest in using robots is to allow the patients to
achieve a large amount of movement in a limited time. Additionally, the attractive human-
machine interface has the capacity to motivate the child to perform his or her therapy through
playful games, such as car races, or to perform exercises that mimic ADLs. Moreover, robotic
devices allow the patient to receive visual, auditory, or sensory feedbacks. Finally, the robot
gives performance-based assistance to the patients. This assistance can enhance the neuronal
plasticity by enabling the patients to initiate and accomplish movements as actively as possible
[125–132]. The strength of RAT is based on repetitive, goal-oriented, cognitive engaging tasks,
which appear to be particularly interesting in the pediatric age, when the neuroplasticity is
recognized to be at its maximum. Robotic therapy might increase functional strength and
improve isolated movements. Because consistency of assistance can be maintained, intensity
and difficulty can be set according to the patient’s improvement. Several groups reported long-
lasting improvements in standing and walking of children with CP. Also, parents and patients
report improvements in terms of quality of life [133–135]. A device specifically developed for
the locomotion training is the Lokomat (Hocoma, CH), made of two active orthoses, a weight-
bearing system and a treadmill. This robotic rehabilitation has been proposed to improve
walking and physical fitness [136]. It is reported that the muscular strength of ankle dorsi‐
flexion and plantarflexion increases in children with cerebral palsy who played a block break
game and an airplane game using robotics in virtual reality three times per week for 12 weeks
[137]. Robotic devices offer children fun and intensive rehabilitation that a human therapist
cannot provide. These robots can be easily integrated as a relevant complement to therapy in
the clinical setting. Studies have shown that combined passive and active training using a
portable robot for children with CP is effective and feasible in a research laboratory and in a
clinical setting. A repetitive, goal-directed, biofeedback training through motivating games in
the laboratory and in the home environment is feasible. Robot-guided therapy can be an option60 Cerebral Palsy - Current Steps